314

Malaria Quarterly Bulletin

July-September 2017

LLINs Distribution, Courtesy Fawad Azhar M&E Coordinator ACD (Peshawar-KP) IN THIS ISSUE

1.1 WHO MISSION VISIT TO PAKISTAN

WHO mission consisting of Dr. Ghasem Zamani (Regional Advisor WHO) and Ryan Williams (DHIS-2 Focal Person WHO) visited Pakistan in July 2017. The purpose of the mission was the assessment of malaria situation in Pakistan in post devolution scenario. Ryan gave an orientation of DHIS-2. Dr. Zamani and Dr. Qutbuddin Kakar (NPO-WHO) visited health facilities in Balochistan, KP, Punjab and Sindh provinces and had meetings with DHOs and other important Government officials

At the end of their visits, a debriefing session was held in Ramada Hotel on 20th July 2017. Participants included senior officials and representatives from National Ministry of Health Services Regulation and Coordination (NMHSR&C), WHO, Provincial Malaria Control Programs, representatives from The Indus Hospital (TIH) and DMC. Dr. Zamani shared findings of his field visits along with key recommendations. He highly appreciated on-going field interventions particularly hard work and commitment of the field workers.

1 Activities Round Up

Directorate of Malaria Control Islamabad, as the Principal Recipient (PR) for the Global Fund New Funding Model (NFM) grant is implementing malaria control interventions in 48 highly endemic districts and agencies of Pakistan through 8 public and private Sub-Recipients (SRs). The Indus Hospital as Co-PR is implementing similar interventions in 18 districts of Khyber Pakhtunkhwa (7) and Balochistan (11) through 2 SRs.

Activities round up WHO Mission visit to Pakistan TWG meeting Moving from manual to online

system DHIS-2 Knowledge Corner Progress of the quarter Pictures from the field

MALARIA QUARTERLY BULLETIN JULY-SEPTEMBER 2017 Issue # 3 Page1

1.2 Technical Working Group (TWG) Meeting

TWG meeting was organized by DMC on 21st July 2017 in Ramada hotel, Islamabad under the leadership of Director DMC, Dr. Abdul Baseer Khan Achakzai. The TWG members included Dr. Qutbuddin Kakar (WHO), provincial program managers and consultants. The key objectives of the meeting were to share the update on ongoing malaria activities with the members of the TWG and seek their inputs and guidance on the technical aspects of various on-going interventions.

1.3 Moving from manual system to online DHIS-2 Malaria module

DMC is determined to have a robust surveillance system (third pillar of Global Technical Strategy) for ensuring accurate and timely reporting of malaria cases from the targeted health facilities. For reporting from TGF funded districts DMC and TIH have strategically planned to shift to an online malaria information system with the support from TGF and technical guidance from WHO. In this regard, an online DHIS-2 malaria module has been developed for reporting of malaria cases and other programmatic achievement. To carry out the process further, a number of consultative meetings with WHO mission, National TB control Program (NTP) and National Ministry of Health Services Regulation and Coordination (NMHSR&C) were held in this regards. During this quarter, another consultative meeting was held between HPSIU, DMC and TIH at NMHSR&C, Islamabad to discuss the progress on development of the Malaria module of DHIS-2. The meeting concluded with certain key decisions. It was decided that DMC and TIH teams will proceed with the implementation of DHIS-2 in all the TGF grant supported districts after the final endorsement and approval by the Director-DOMC. The trainings of the District Management Units (DMUs) and relevant MIS and district staff of PRs and SRs will be completed before end of December 2017.

2. KNOWLEDGE CORNER World Malaria Report 2017- Highlights According to the latest World Malaria Report,

In 2016, 216 million cases of malaria have been reported, increasing from around 211 million cases in 2015.

Estimated number of malaria deaths stood at 445,000 in 2016.

In areas with high transmission of malaria, children under 5 are particularly susceptible to infection, illness and death; more than two thirds (70%) of all malaria deaths occur in this age group.

The number of under-5 malaria deaths has declined from 440,000 in 2010 to 285,000 in 2016.

Malaria remains a major killer of children under five years old, taking the life of a child every two minutes.

Core Principles of Malaria Management 1. Early diagnosis and prompt treatment All suspected cases should have a parasitological test (RDT or Microscopy) to confirm the diagnosis. 2. Rational use of antimalarial drugs To reduce the spread of drug resistance, antimalarial medicines should only be administered to confirmed malaria patients. Adherence to full treatment course should be promoted. 3. Combination therapy All episodes of malaria should be treated with at least two effective antimalarial medicines with different mechanisms of action. 4. Appropriate weight based dosing Dosage regimens should be based on patient’s weight and should provide effective concentrations of antimalarial drugs for a sufficient time to eliminate the infection in all target population.

TWG meeting organized by DMC

Page 2 of 5

3.1 Malaria cases A total of 5434 diagnostic centers (Microscopy+ RDT) are now fully functional in 66 targeted districts and agencies with the support of TGF grant, supported by DMC (3006) and TIH (2428). Many new districts (stratum 1-c) started reporting during this quarter.

In the reporting quarter, a total of 1,098,853 cases were screened across the TGF supported districts. A total of 162,629 confirmed malaria cases were reported during this quarter. Highest number of cases were reported from KP (51,698; 32%), followed by Sindh (45,255; 28%), FATA (35,482; 22%) and Balochistan (28,811; 17%). A total of 1383 cases were reported from DG Khan-Punjab. (Refer to Figure 1 and 2). PV cases were the highest in number to be reported (135,437; 83%), followed by PF (21,563; 13%) and Mix (5,629; 3%).

3.2 Long Lasting Insecticidal Nets (LLINs) distribution

A total of 65,091 LLINs were distributed during the quarter across TGF covered districts and agencies to the general population through mass distribution and to the pregnant women through ANC clinics. Highest number of LLINs were distributed in KP (28,628) followed by Balochistan and Sindh (Figure 3).

FAST FACTS

Total Number of cases 162,629

PV cases 83%, PF 13% and Mix 3%

Cases from KP 51,698 (Highest)

Cases from Sindh 45,255

Cases from FATA 35,482

Cases from Balochistan 28,811

Cases from DG. Khan-Punjab 1,383

Figure 1: Malaria Cases – Province wise distribution Figure 2: Province wise distribution of cases according to species

Figure 3: LLINs distribution from Jul–Sep 2017 across the districts-agencies

1,383

28811

35,482

45,255

51698

798

18141

32,40833,777

50313

416

73252,369

10,433

1020169

3345705 1,045 365

05,000

10,00015,00020,00025,00030,00035,00040,00045,00050,00055,000

Punjab Balochistan FATA Sindh KP

Total PV PF MixPunjab1%

Balochistan17%

FATA22%

Sindh28%

KP32%

12600

2386328628

65091

0

10000

20000

30000

40000

50000

60000

70000

Sindh Balochistan KP Total

3. PROGRESS OF THE QUARTER

Page 3 of 5

3.3 Capacity Building

During the quarter, trainings were conducted on Malaria case management, Malaria diagnosis, Malaria Information System and outbreak response. A total of 1179 personnel were trained in TGF targeted districts and agencies. (Refer to figure 4)

3.4 Monthly Cluster Meetings

Regular monthly cluster meetings were conducted to ensure optimal coordination, ownership and smooth flow of data from districts to the provincial and federal levels. A total of 328 cluster meetings were carried out across TGF districts. (Refer to figure 5)

3.5 Behavior Change Communication (BCC)

activities

During the quarter advocacy sessions as well as awareness sessions were carried out. Advocacy sessions are carried out by SRs in which LHWs/ CBO/ NGOs are trained as community advocates. A total of 14,052 advocates were trained during the reporting quarter. These advocates further carried out awareness sessions in the community reaching a population of 396,011 in the reporting quarter.

Figure 4: Number of personnel trained in the reporting quarter

Figure 5: Number of cluster meetings conducted in the reporting quarter

78212

889

1179

0

200

400

600

800

1000

1200

Casemanagement

MalariaDiagnosis

MIS &outbreakresponse

Total

6 57 66 80119

328

0

50

100

150

200

250

300

350

Pujnab FATA KP Sindh Balochistan Total

Awareness session in Panjgur-Balochistan

Page 4 of 5

5. PICTURES FROM THE FIELD

Training of Doctors on Malaria case management Badin – Sindh by NRSP

LLINs distribution in KP by ACD

Advocacy session – Panjgur Balochistan by NRSP/BRSP

Distribution of Solar Microscopes in KP by ACD

Page 5 of 5